IN RE BLUE CROSS BLUE SHIELD ANTITRUST LITIGATION

No. 22-13051.

85 F.4th 1070 (2023)

IN RE: BLUE CROSS BLUE SHIELD ANTITRUST LITIGATION MDL 2406. Galactic Funk Touring, Inc., American Electric Motor Services, Inc., CB Roofing, LLC, Pearce, Bevill, Leesburg, Moore, P.C., Pettus Plumbing & Piping, Inc., et al., Plaintiffs-Appellees, Topographic, Inc., Employee Services Inc., Home Depot U.S.A., Inc., Jennifer Cochran, Aaron Craker, David G. Behenna, Interested Parties-Appellants, v. Anthem, Inc., Excellus Health Plan, Inc., d.b.a. Excellus BlueCrossBlueShield, Premera Blue Cross, Blue Cross-Blue Shield of Arizona, Health Care Service Corporation, et al., Defendants-Appellees.

United States Court of Appeals, Eleventh Circuit.

Filed: October 25, 2023.


Attorney(s) appearing for the Case

Scott Burnett Smith , Bradley Arant Boult Cummings, LLP, Huntsville, AL, Virginia Adamson , Bradley Arant Boult Cummings, LLP, Nashville, TN, Henry D. Hoss , Mark Richard Mullins , Richard Nix , Mark D. Spencer , McAfee & Taft, PC, Oklahoma City, OK, Michael R. Pennington , John Thomas Richie , Emily Myers Ruzic , Bradley Arant Boult Cummings, LLP, Birmingham, AL, for Interested Parties-Appellants Topographic, Inc., Employee Services Inc.

Frank M. Lowrey, IV , Ronan Doherty , Edwin Allen Page , Bondurant Mixson & Elmore, LLP, Atlanta, GA, for Interested Party-Appellant Home Depot U.S.A., Inc.

David Boies , Boies Schiller & Flexner, LLP, Armonk, NY, William A. Isaacson , Paul Weiss Rifkind Wharton & Garrison, LLP, Washington, DC, Vincent J. Colatriano , Charles J. Cooper , Harold S. Reeves , Cooper & Kirk, PLLC, Washington, DC, Ben W. Gordon, Jr. , Levin Papantonio Rafferty, Pensacola, FL, Michael Hausfeld , Hausfeld, LLP, Washington, DC, Hamish P. M. Hume , Boies Schiller & Flexner, LLP, Washington, DC, Megan Jones , Hausfeld, LLP, San Francisco, CA, Rebekah Keith McKinney , Watson McKinney, LLP, Huntsville, AL, Mario Anthony Pacella , Strom Law Firm, Columbia, SC, Barry Alan Ragsdale , Dominick Feld Hyde, PC, Birmingham, AL, Adam R. Shaw , Boies Schiller & Flexner LLP, Albany, NY, Eric B. Snyder , Bailey & Glasser, LLP, Morgantown, WV, for Plaintiffs-Appellees Galactic Funk Touring, Inc., American Electric Motor Services, Inc., CB Roofing, LLC, Pearce, Bevill, Leesburg, Moore, P.C., Pettus Plumbing & Piping, Inc.

George Willard Cochran, Jr. , Law Office of George W. Cochran, Kent, OH, for Interested Party-Appellant Jennifer Cochran.

Jennifer Cochran, Louisville, KY, Pro Se.

George Willard Cochran, Jr. , Law Office of George W. Cochran, Kent, OH, for Interested Party-Appellant Aaron Craker.

Aaron Craker, Louisville, KY, Pro Se.

David G. Behenna, Portsmouth, NH, Pro Se.

David Boies , Boies Schiller & Flexner, LLP, Armonk, NY, William A. Isaacson , Paul Weiss Rifkind Wharton & Garrison, LLP, Washington, DC, Vincent J. Colatriano , Charles J. Cooper , Harold S. Reeves , Cooper & Kirk, PLLC, Washington, DC, Michael Hausfeld , Hausfeld, LLP, Washington, DC, Hamish P. M. Hume , Boies Schiller & Flexner, LLP, Washington, DC, Megan Jones , Hausfeld, LLP, San Francisco, CA, Adam R. Shaw , Boies Schiller & Flexner LLP, Albany, NY, for Plaintiffs-Appellees Consumer Financial Education Foundation of America, Inc., Fort McClellan Credit Union, Rolison Trucking Co., LLC, Conrad Watson Air Conditioning, Inc., Linda Mills, Frank Curtis, Jennifer Ray Davidson, Pete Moore Chevrolet Inc., Jewelers Trade Shop, Saccoccio & Lopez, Angel Foster, Monika Bhuta, G & S Trailer Repair Incorporated, Chelsea Horner, Montis, Inc., Renee Allie, John G. Thompson, Hess, Hess & Daniel, P.C., Betsy Jane Belzer, Bartlett, Inc, Matthew Alden Boyd, Gaston CPA Firm, Rochelle McGill, Brian McGill, Sadler Electric, Amy Macrae, Vaughan Pools, Inc., Casa Blanca, LLC, Jennifer D. Childress, Jennifer D. Childress, Janeen Goodin, Marla Sharp, Erik Barstow, GC/AAA Fences, Inc., Angie Hill, Christy Bradberry, Kevin Bradberry, Juanita Aschenbrenner, Free State Growers, Inc., Jason Goodman, Tom Goodman, Comet Capital, LLC, Barr, Sternberg, Moss, Lawrence, Silver & Munson P.C., Mark Krieger, A. Duie Pyle, Inc., Deborah Piercy, Lisa Tomazzoli, Hibbett Sports.

David Boies , Boies Schiller & Flexner, LLP, Armonk, NY, William A. Isaacson , Paul Weiss Rifkind Wharton & Garrison, LLP, Washington, DC, Vincent J. Colatriano , Charles J. Cooper , Harold S. Reeves , Cooper & Kirk, PLLC, Washington, DC, Michael Hausfeld , Hausfeld, LLP, Washington, DC, Hamish P. M. Hume , Boies Schiller & Flexner, LLP, Washington, DC, Adam R. Shaw , Boies Schiller & Flexner LLP, Albany, NY, for Plaintiff-Appellee Michael E. Stark.

David Boies , Boies Schiller & Flexner, LLP, Armonk, NY, William A. Isaacson , Paul Weiss Rifkind Wharton & Garrison, LLP, Washington, DC, Vincent J. Colatriano , Charles J. Cooper , Harold S. Reeves , Cooper & Kirk, PLLC, Washington, DC, Michael Hausfeld , Hausfeld, LLP, Washington, DC, Hamish P. M. Hume , Boies Schiller & Flexner, LLP, Washington, DC, Megan Jones , Hausfeld, LLP, San Francisco, CA, for Plaintiff-Appellee Avantgarde Aviation, Inc.

David Boies , Boies Schiller & Flexner, LLP, Armonk, NY, Vincent J. Colatriano , Charles J. Cooper , Harold S. Reeves , Cooper & Kirk, PLLC, Washington, DC, Michael Hausfeld , Hausfeld, LLP, Washington, DC, Hamish P. M. Hume , Boies Schiller & Flexner, LLP, Washington, DC, for Plaintiff-Appellee Jeffery Garner.

David Boies , Boies Schiller & Flexner, LLP, Armonk, NY, William A. Isaacson , Paul Weiss Rifkind Wharton & Garrison, LLP, Washington, DC, Vincent J. Colatriano , Charles J. Cooper , Harold S. Reeves , Cooper & Kirk, PLLC, Washington, DC, Hamish P. M. Hume , Boies Schiller & Flexner, LLP, Washington, DC, Megan Jones , Hausfeld, LLP, San Francisco, CA, Adam R. Shaw , Boies Schiller & Flexner LLP, Albany, NY, for Plaintiff-Appellee Tom Aschenbrenner.

Vincent J. Colatriano , Cooper & Kirk, PLLC, Washington, DC, Kimberly West , Wallace Jordan Ratliff & Brandt, LLC, Birmingham, AL, for Defendant-Appellee Anthem, Inc.

Edward Bloomberg , John G. Schmidt, Jr. , Phillips Lytle, LLP, Buffalo, NY, Anna Mercado Clark , Phillips Lytle LLP, The New York Times Building, New York, NY, Kimberly West , Wallace Jordan Ratliff & Brandt, LLC, Birmingham, AL, for Defendant-Appellee Excellus Health Plan, Inc.

Gwendolyn C. Payton , Kilpatrick Townsend & Stockton LLP, Seattle, WA, Adam Howard Charnes , Kilpatrick Townsend & Stockton LLP, Dallas, TX, Harold S. Reeves , Cooper & Kirk, PLLC, Washington, DC, Kimberly West , Wallace Jordan Ratliff & Brandt, LLC, Birmingham, AL, for Defendant-Appellee Premera Blue Cross.

Karin DeMasi , Helam Gebremariam , Lauren Kennedy , David Korn , Cravath Swaine & Moore, LLP, New York, NY, Kimberly West , Wallace Jordan Ratliff & Brandt, LLC, Birmingham, AL, for Defendant-Appellee Blue Cross Blue Shield of Arizona.

Vincent J. Colatriano , Cooper & Kirk, PLLC, Washington, DC, Karin DeMasi , David Korn , Cravath Swaine & Moore, LLP, New York, NY, Kimberly West , Wallace Jordan Ratliff & Brandt, LLC, Birmingham, AL, for Defendant-Appellee Health Care Service Corporation.

David Boies , Boies Schiller & Flexner, LLP, Armonk, NY, William A. Isaacson , Paul Weiss Rifkind Wharton & Garrison, LLP, Washington, DC, Vincent J. Colatriano , Charles J. Cooper , Harold S. Reeves , Cooper & Kirk, PLLC, Washington, DC, Michael Hausfeld , Hausfeld, LLP, Washington, DC, Hamish P. M. Hume , Boies Schiller & Flexner, LLP, Washington, DC, Megan Jones , Hausfeld, LLP, San Francisco, CA, Adam R. Shaw , Boies Schiller & Flexner LLP, Albany, NY, for Defendants-Appellees Keith Cerven, Teresa M. Cerven, Sirocco, Inc., Kathryn Scheller, Iron Gate Technology, Inc., Nancy Thomas, Pioneer Farm Equipment, Inc., Scott Morris, Deborah Forsythe, Tony Forsythe, Joel Jameson, Ross Hill.

Evan R. Chesler , Karin DeMasi , Helam Gebremariam , Lauren Kennedy , David Korn , Cravath Swaine & Moore, LLP, New York, NY, for Defendants-Appellees Blue Cross and Blue Shield Association, Blue Cross and Blue Shield of Florida, Inc., Guidewell Mutual Holding Corp., Blue Cross and Blue Shield of Massachusetts, Inc., Group Hospitalization and Medical Services, Inc., Carefirst Bluechoice, Inc., Hawaii Medical Service Association, Wellmark of South Dakota, Inc., Wellmark Inc.

Evan R. Chesler , Karin DeMasi , Helam Gebremariam , Lauren Kennedy , David Korn , Cravath Swaine & Moore, LLP, New York, NY, Jeffrey J. Zeiger , Kirkland & Ellis, LLP, Chicago, IL, for Defendants-Appellees Caring for Montanans, Inc., Health Care Service Corporation.

Karin DeMasi , Helam Gebremariam , Lauren Kennedy , David Korn , Cravath Swaine & Moore, LLP, New York, NY, Harold S. Reeves , Cooper & Kirk, PLLC, Washington, DC, for Defendants-Appellees Blue Cross and Blue Shield of North Carolina, Blue Cross and Blue Shield of Tennessee, Inc., California Physicians' Service, Carefirst, Inc., Carefirst of Maryland, Inc.

Barry Alan Ragsdale , Dominick Feld Hyde, PC, Birmingham, AL, for Defendants-Appellees Charles Barnwell, Judith Kanzic, M.D., James Snowden, M.D., Dena Olwan, M.D., Joseph Ferezy, M.D., Ear, Nose & Throat Consultants & Hearing Services, PLC, Saket K. Ambasht, John Nolte, M.D., Hillside Family Medicine, Harbir Makin, Luis Pernia, M.D., Joseph Ackerson, Prorehab, Breakthrough Physical Therapy, PC, Dunn Physical Therapy, Texas Physical Therapy Specialists, Jerry Conway, M.D., Julie McCormick, North Jackson Pharmacy Inc., Jackson Medical Center, LLC, Evergreen Medical Center, Crenshaw Community Hospital, Ivy Creek Healthcare, Bullock County Hospital, Charles Clark, III, M.D., Neuromonitoring Services of America, Michael Dole, M.D., Michael Dole, M.D., MD, APMC, Michael Dole, M.D., LLC, Spine Diagnostic Center of Baton Rouge, Matthew Caldwell, M.D., Greater Brunswick Physical Therapy, Gaspar Physical Therapy, Janine Nesin, PT DPT, OCS, Caen Hund, M.D., Kathleen Cain, M.D., Corey Musselman, Robert Nesbitt, M.D., Mishante Reyes, M.D., Timothy Hendlin, M.D., Brian Roadhouse, M.D., Blue Cross and Blue Shield of Alabama.

Martin Patrick McDowell , Brunini Grantham Grower & Hewes, PLLC, Jackson, MS, for Defendant-Appellee Blue Cross and Blue Shield of Mississippi.

Todd Stenerson , Shearman & Sterling, LLP, Washington, DC, for Defendant-Appellee Blue Cross and Blue Shield of Michigan.

Honor Costello , Sarah Gilbert , Crowell & Moring, LLP, New York, NY, Tracy Roman , Kathleen Taylor Sooy , Crowell & Moring, LLP, Washington, DC, for Defendants-Appellees Blue Cross of Idaho Health Service, Inc., Blue Cross and Blue Shield of Kansas, Inc., Blue Cross and Blue Shield of Kansas City, Blue Cross and Blue Shield of Nebraska, Blue Cross Blue Shield of North Dakota, Blue Cross Blue Shield of Wyoming.

Jeffrey J. Zeiger , Kirkland & Ellis, LLP, Chicago, IL, for Defendants-Appellees Highmark West Virginia Inc., Highmark Inc., Highmark Blue Cross Blue Shield Delaware Inc., Highmark Western and Northeastern New York Inc.

John DeQ. Briggs , Axinn Veltrop & Harkrider, LLP, Washington, DC, Aaron Gavin McLeod , Stephen Ashford Rowe , Adams & Reese, LLP, Birmingham, AL, for Defendant-Appellee Independence Hospital Indemnity Plan, Inc.

Alan D. Rutenberg , Foley & Lardner, LLP, Washington, DC, for Defendant-Appellee Usable Mutual Insurance Company d/b/a Arkansas Blue Cross and Blue Shield.

Jess R. Nix , Robert K. Spotswood , Spotswood Sansom & Sansbury, LLC, Birmingham, AL, for Defendant-Appellee Capital Blue Cross.

Karin DeMasi , Lauren Kennedy , David Korn , Cravath Swaine & Moore, LLP, New York, NY, for Defendant-Appellee BlueCross BlueShield of South Carolina.

Kimberly Hunter , Oklahoma Insurance Department, Oklahoma CITY, OK, for Amici Curiae Oklahoma Insurance Department, Arkansas Insurance, Department Insurance, Georgia Office of Safety Fire Commissioner, Idaho Department of Insurance, Maine Bureau of Insurance, Nevada Division of Insurance, Vermont Department of Financial Regulation, Washington Office of the Insurance Commissioner, Wisconsin Office of the Commissioner of Insurance.

Jay Michael Ezelle , Benjamin T. Presley , Huey Thomas Wells, III , Starnes Davis Florie, LLP, Birmingham, AL, for Amid Curiae Alaska Air Group, Inc., Alaska Air Group, Inc. Welfare Benefit Plan, Alaska Airlines, Inc., Alaska Airlines, Inc. Welfare Benefit Plan, Horizon Air Industries, Inc., Horizon Air Industries, Inc. Welfare Benefit Plan, New Albertsons L.P.

Benjamin T. Presley , Huey Thomas Wells, III , Starnes Davis Florie, LLP, Birmingham, AL, for Amici Curiae Albertsons Companies, Inc., Employee Benefit Plan for Employees of Horizon Air Industries, Inc., Employee Benefit Plan for Full-Time and Part-Time Employees Horizon Air Industries, Inc.

Before William Pryor, Chief Judge, Abudu, Circuit Judge, and Barber, District Judge.


This appeal requires us to determine whether the district court abused its discretion in approving a settlement agreement for a multi-district antitrust class action against the Blue Cross Blue Shield Association and its member plans. One objector, Home Depot U.S.A., Inc., contends that the settlement violates public...

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